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Don Berwick Before Ways and Means

by Benjamin Domenech on February 10, 2011

Updated throughout the morning. Statements paraphrased, obviously.

-This appearance had several fascinating moments, mostly because — unlike Berwick’s prior abbreviated hearing before the Senate — several Representatives seemed well versed on his views and called his equivocations as they happened. As we go over Berwick’s answers, his responses to Reps. Gerlach, Reichert, and Price all asked tough questions which required him to either dodge or discount his past remarks. It also led to a side-by-side moment that is really made for TV — Berwick today saying: “I abhor rationing. My entire life has been spent fighting rationing.” Compared to the quote from Berwick in 2009: “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open.”

-Last questions for Berwick on disparity in Medicare payments for rural care from Rep. Paulsen. Berwick going out with a whimper. “I’d be concerned as you are [on increased regulations on states.]” You’ve spent the entire hearing supporting Obama’s law — which is nothing but increased regulations.

-Jenkins: “Do you think it is in the best interest of the American people to continue to implement this law spending a lot of taxpayer dollars given that we don’t know if it will stand?” Berwick: “I’m not a lawyer, I listen to counsel… I will continue to implement it.” Jenkins: “You don’t have any plan to recoup the costs [should law be struck down]?” Berwick: “Let’s talk about that downstream.”

-Rep. Jenkins on IPAB. “I am concerned about 15 unelected bureaucrats on board, and concerned about limited opportunity for Congressional review.”

-Schock asks about implementation post Florida and Virginia. Berwick says he’ll have to ask DOJ, but he will continue implementing law.

-Rep. Schock points out that his father, a doctor, is quitting because of Obamacare. Asks about making care less expensive. “Do you believe the bill will make the coverage most Americans receive less costly?” “…It will benefit the private and the public side of payment.”

-FYI from Congressional source: Berwick CAN be recess appointed again after term expires at end of year. But could not be paid for work: “2009 appropriations law included a provision which prevents any Administration from effectively hiring a controversial nominee like Dr. Berwick as a politically-appointed senior managed (non-career SES) and then having that person designated Acting administrator of an agency. The provision was implemented in response to Congressional concerns over the Bush Administration’s nominee for MSHA Assistant Secretary, Richard Stickler.”

-Berwick: “Medicare Advantage is stronger than it was before” thanks to Obamacare. In response to Democrat questioners, Berwick keeps citing fact that Medicare Advantage enrollment is up this year. But how is this a response to future cuts?

-If you’d like to listen to an interview on this I did before the hearings began, you can do so at Coffee and Markets.

-Berwick admits “There’s more fraud and abuse than I thought” in Medicare and Medicaid system.

-Price followup demands promise that no doctors’ licenses will be tied to participation in the plan. Here’s the issue he was talking about, which Berwick claimed ignorance of.

-Rep. Tom Price is up, third generation physician. “I think you missed your calling, you’d have made a great lawyer,” he tells Berwick. “Is it true that if you like what you have, you can keep it?” “I don’t understand the question.” “How about this then: has anyone lost coverage that they liked?”

-Berwick asked about medical liability. “Are you open to federal leg that would include caps on non-economic lawsuits?” “Not my area.” But says he supports the idea generally.

In his 1996 book “New Rules: Regulation, Markets, and the Quality of American Health Care,” written with Troy Brennan, Berwick took a different view:

“Although its somewhat neutral moniker would suggest otherwise, tort reform is chiefly an effort by chronic defendants to obtain changes in law that will make it more difficult for plaintiffs to bring claims. Tort reform intends to make claims less valuable for the plaintiff’s attorney, the critical economic player in medical malpractice litigation.”

“Tort reform does not necessarily promote better quality care; just the opposite may be true. Insofar as these reforms reduced claims rates, they also reduced the deterrent effect associated with malpractice litigation, in theory thereby increasing the number of medical injuries due to substandard care.”

-Rep. Lewis asks about benefits for the young and the poor. “I didn’t just like your testimony, I loved it.”

-Rep. Gerlach reads several quotes from Berwick’s past statements into the record, notes that he feels like his views are “from a different country.”

-Rep. Heller: “Your testimony is full of platitudes.” Frustrated with Berwick dodging on reimbursement issues.

-Rep. McDermott tees up criticism of Paul Ryan’s voucher based Medicare solution as his focus. But Berwick won’t denounce idea. “I don’t think I know [whether seniors would oppose].” Interesting that he seems to be dodging the Democrat softballs as skittishly as the Republicans’ tougher questioning.

-Reichert hammering away on this, cites Obama statement there is language in bill which runs contrary to keeping health care they like. “President Obama visited our retreat last year and he was asked about whether you can keep your health care plan if you like it. However, in his comments to us he said, well, there may have been some language snuck into the bill that runs contrary to that premise… Would you change that?” “Well…” “Why would you not change that? Yes or no?” After an objection from the minority, Berwick gathers himself: “I’m not aware of any language which says that in the bill.”

-Rep. Reichert: “Would you agree that people can keep their plan, their care if they like it?” Berwick: “It seems so.” “Is there anything about the bill you would change?” “Um” “Is there anything about it you don’t like?” “Well…” “I’m going to ask for yes or no, just answer the question.”

-Rep. Davis slams “equivocation” from Berwick’s “lack of candid” answers. “Is the actuary correct?” “He’s making a prediction about the future…” “That’s not an answer.” Davis’s West Point education coming through: “You lead a budget larger than the Defense Department sir. Answer the question.” “…Medicare Advantage looks healthy.”

-Berwick says government has “no role at all” in doctors office. Unless it’s a script for people to use in NHS on end of life.

-Rep Tiberi: “My father in law lost his doctor because he stopped taking Medicare under new law.” But talks so long in telling story, Berwick only has to answer for ten seconds.

-Rep. Brady hounds Berwick on Medicare Advantage enrollment. “Your actuaries say 7.4 million will lose, are they not correct?”

-Rep. Brady hounds Berwick on enrollment on Medicare Advantage.

-Rep. Rangel advances a view that is extremely wrong — that uninsured people drive costs in Emergency Rooms. Largely debunked.

-Berwick being asked by Rep. Johnson about access given Medicare cuts. “How do you plan to allow access given these cutbacks?” Very vague answer.

-One thing that newer Representatives need to learn is that they can easily enter their statements into the record and jump right to questions. This is something Republicans frequently don’t do. Long opening statements only shorten the number of questions you can ask.

-”On the whole, good,” Berwick says in answer to the question from Rep. Herger on whether he thinks that “market forces will help our health care system.” This of course conflicts with his past statements. . Here’s Berwick denouncing market forces in health care.

-Note: the NHS system Berwick no longer seems willing to declare he loves may have the highest Quality of Death (read: painkillers), but it lags well behind in other categories according to Lancet Oncology and other measures.

The real-world outcomes of Berwick’s “global treasure” are appallingly poor. The NHS’s system of state-controlled rationing turns treatable diseases into death sentences. UK cancer survival rates are near the bottom for all of Europe according to the first worldwide study of cancer survival rates (published two years ago in Lancet Oncology). Women who contract breast cancer there have a 46 percent mortality rate, compared with only 25 percent in the United States. Only 19 percent of American men who get prostate cancer die of it, but in Britain it kills 57 percent. The U.K.’s overall cancer mortality rate is more than 38 percent higher than America’s.

-Chairman Dave Camp is pressing Berwick on market issues and other questions. His opening remarks are here. Berwick is dodging on whether or not he’s still “in love” with Britain’s National Health Service.

-As questioning begins, Berwick describes Obamacare as a “terrific investment.” He claims “In 2011, premiums are lower and enrollment is projected to be higher than ever before.” This raises a few eyebrows.

-Don Berwick’s testifying before the House Ways and Means Committee as we speak. His opening statement as prepared for release contains few surprises, though he did single out the House for criticism for their reform vote, saying:

“This law means real improvements for Medicare beneficiaries, now and in the future. That’s why the House vote to repeal this law was unfortunate.”

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